Eye Laser for Shortsightedness

Laser eye surgery is a medical procedure that involves the use of a laser to reshape the surface of the eye. This is done to improve or correct shortsightedness, long-sightedness and astigmatism. It can also be helpful in overcoming presbyopia (difficulty seeing up close as we get older).

Shortsightedness is more accurately known as myopia. With short-sight (or near-sight in the USA), vision is best at short range, hence the name. Near objects such as text, print, and mobile phones are clear. The distance vision, however, is blurry, making it difficult to watch television or a film, read subtitles or drive a car.

When someone suffers from short sight (near-sight), they will require corrective lenses, either spectacles or contact lenses. Such glasses or lenses will allow the distance vision to become clear.

Laser surgery can cure short-sight once the condition is no longer progressing, and LASIK is the preferred option. Key points for LASIK:

The treatment of choice for myopia
The laser takes 5-10 seconds to evaporate away a very thin layer of tissue within the cornea, flattening its overall curvature
The whole procedure is complete in 4-5 minutes per eye

See below for more information on the different procedure types available for short-sightedness.

Laser vision surgery (LASIK) for short-sight is the treatment of choice in most cases. 97% of Focus patients receive A-LASIK and 3% undergo PRK.

A-LASIK is an advanced form of LASIK utilising a high numerical aperture femtosecond laser to create the LASIK flap, creating a remarkably accurate focus for precision treatment.

Using the WaveLight laser, which removes less corneal tissue per dioptre than other lasers, we are able to treat most patients up to -10.00 dioptres. This represents more than 98% of all short-sighted prescriptions.

In a normal eye light enters through the cornea, passes through the pupil (the natural opening in the iris) and continues through the lens located just behind the iris. If there is no refractive error (a glasses prescription) the cornea and lens focus the parallel light rays to converge together to make a sharp image on the retina. This light-sensitive layer converts the light into information that passes along the optic nerve emerging from the back of the eye, taking the vision data to the rear part of the brain; the so-called occipital lobe then processes this information so that you get a visual perception and awareness of the world around you.

The cause of short-sighted blur

Myopia, the medical term for near-sightedness, is most commonly caused by growth of the eyeball, with the eye becoming longer from front to back. Often the front focusing part of the eye (the cornea and lens) is completely normal but the ‘screen’ where the image is projected onto is too far back. The image is now incorrectly in front of the retina, with the light rays crossing and continuing to form a blurred image.

Progression of myopia – when to have treatment

Myopia typically begins in the teenage years, and gradually progresses with worsening distance vision over the next 10-15 years. With higher levels of short-sight the condition may begin before the age of 10.

Previously, myopia would stabilise in the early 20s and the patient would no longer need regular increases in the strength of their glasses. In recent years, with much greater use of computer screens, mobile phones, and handheld devices, we are seeing myopia continue to progress through the 20s and even into the 30s. Some reports have even talked about an “epidemic of myopia”.

Some children do not realise at first that their sight is not as good as it could be. They may be able to read books and do close work without difficulty. However, seeing distant objects such as the board at school may become hard. They may think this is normal and not tell anyone. Schoolwork may suffer for a period before the condition is identified and treatment provided.

Most patients are ready to have laser eye correction between 25 and 30, although some may be ready earlier, depending on, e.g. when they first needed glasses.

Myopia (Short-Sightedness) Procedure Types

There are three forms of treatment for myopia, although the first, laser eye surgery, is by far the most used:

Laser eye surgery: LASIK and PRK/LASEK
Refractive lens exchange (RLE)
Implantable contact lenses (ICL)

LASIK is the most performed eye surgery in the world, after cataract surgery, and is most likely the procedure you will have if you are short-sighted.

History of laser eye treatment

PRK was the first form of laser eye surgery introduced in first in late 1988. LASIK was introduced soon afterwards in 1989, performed by Ioannis Pallikaris in Crete. LASIK soon became the most popular procedure due to its lack of pain and rapid visual recovery.

How does the laser correct vision?

Like other forms of refractive surgery, LASIK and PRK reshape the cornea to enable light entering the eye to be correctly focused on the retina for clear vision.

To correct myopia, the cornea needs to be flattened and made less powerful as a lens. This is achieved using an excimer laser, a cool-beam ultraviolet device that can evaporate corneal tissue without burning. Each pulse of the laser removes a depth of 0.2 microns (thousandths of a millimetre). Pulses are scattered across the cornea in a pre-determined pattern to remove enough tissue to correct the specific prescription being treated.

Using the extremely fast WaveLight laser, most prescriptions can be fully treated in only 4-10 seconds.

LASIK Procedure for Short-Sightedness Vision Correction

LASIK, or “laser-assisted in situ keratomileusis,” is the most commonly performed surgery to correct myopia (short- or nearsightedness). It can also be used for hyperopia (long- or farsightedness) and astigmatism. At Focus Clinic, LASIK is the treatment of choice for 97% of cases.

First, one of our surgeons uses a Ziemer femtosecond laser to create a very thin, precise circular “flap” in the cornea. N.B. An older version of LASIK used a mechanical surgical tool called a microkeratome – this is outdated and should be avoided.

The surgeon then gently folds back the hinged flap to gain access to the underlying cornea (known as the stroma) before using the WaveLight excimer laser to correct your short-sighted prescription.

After the laser has corrected the cornea, the flap is then laid back in place covering the area where the corneal tissue was removed. Then cornea is allowed to heal naturally. The skin surface will seal the edge of the flap within 4 hours.

Surgery requires only topical anaesthetic drops, and no bandages or stitches are needed.

In most cases LASIK is pain-free and completed within 10 minutes for both eyes. The results are usually obvious instantly – most patients can see fairly well as soon as they sit up and achieve 20/20 vision between 5 and 30 minutes after the end of the procedure.

The PRK procedure for myopia

PRK (an acronym for photo-refractive keratectomy) is a type of laser refractive surgery to correct near-sight. It can also be used for mild degrees of hyperopia (farsightedness) and astigmatism.

You will also see this treatment being referred to as LASEK and involves a minor difference in the handling of the surface skin layer. However, both procedures are identical in visual outcomes and pain. Healing time can take longer with LASEK, and so in practice PRK is the most common of these two ‘surface ablation’ techniques. In effect you can use the terms PRK and LASEK interchangeably.

PRK was the first type of laser eye surgery for vision correction and was first performed in 1988. It is the fore-runner to the most commonly performed procedure: LASIK.

PRK recovery takes a longer than recovery from LASIK eye surgery, between 3 and 5 days for most patients. The first 2-3 days are often painful and vision is not very clear.

PRK is still commonly performed and is used mainly when LASIK is not possible, for example a thin cornea or when the patient expresses a preference. Like LASIK excimer surgery, PRK works by reshaping the cornea allowing light entering the eye to be correctly focused on the retina for clear sight.

LASIK and PRK Surgery

With the WaveLight system, we do not tell the laser which procedure is being performed – the excimer laser ablation is exactly the same for PRK and for LASIK

For both PRK and LASIK, the excimer laser sculpts the stromal layer of the cornea to correct your prescription. The main difference between PRK and LASIK is that with LASIK a thin, hinged flap is created on the cornea to access the inner layers; in PRK no flap is created – just the surface skin layer is removed and the excimer laser energy is applied to the top layer of corneal collagen (the stroma).

Is Laser Eye Surgery Painful

Laser eye surgery, also known as refractive surgery, is a common procedure used to correct vision problems such as nearsightedness, farsightedness, and astigmatism. One of the most common concerns among patients considering laser eye surgery is whether the procedure is painful. Let’s delve into the details to determine if laser eye surgery is actually painful.

Understanding Laser Eye Surgery

Laser eye surgery involves reshaping the cornea of the eye to improve vision. There are different types of laser eye surgery, such as LASIK, PRK, and SMILE, each with its own unique technique. During the surgery, a laser is used to remove a small amount of tissue from the cornea, correcting the refractive error in the eye.

The Pain Factor

While the thought of having a laser pointed at your eye may seem unnerving, the majority of patients who undergo laser eye surgery report minimal discomfort during the procedure. Here’s why:

Anesthetic eye drops are used to numb the eye before the surgery, minimizing any potential pain.
Most patients only experience a slight pressure on the eye during the procedure, rather than pain.
The surgery itself is quick, typically lasting only a few minutes per eye.

Postoperative Discomfort

After the surgery, some patients may experience mild discomfort or irritation in the eyes for a few days. This can be managed with over-the-counter pain medication and eye drops prescribed by the surgeon. It is important to follow all postoperative care instructions to ensure a smooth recovery.

Factors Affecting Pain Perception

The level of pain experienced during laser eye surgery can vary from person to person. Factors that may influence pain perception include:

Individual pain tolerance
Level of anxiety or fear about the procedure
Type of laser eye surgery being performed

Who Should Not Have Laser Eye Surgery

Complications that result in a loss of vision are very rare. But certain side effects of LASIK eye surgery are common. These include dry eyes and temporary visual problems such as glare. These symptoms usually clear up after a few weeks or months. Few people consider them to be a long-term problem.

Risks of LASIK surgery include:

Dry eyes. LASIK surgery causes a temporary decrease in tear production. For the first six months or so after your surgery, your eyes may feel unusually dry as they heal. Dry eyes can reduce the quality of your vision.Your eye doctor might recommend eye drops for dry eyes. If you experience severe dry eyes, your eye doctor may recommend additional management, including tear drain plugs or medicated eye drops.
Glare, halos and double vision. You may have a hard time seeing at night after surgery. This usually lasts a few days to a few weeks. You might notice increased light sensitivity, glare, halos around bright lights or double vision.Even when a good visual result is measured under standard testing conditions, your vision in dim light (such as at dusk or in fog) may be reduced to a greater degree after the surgery than before the surgery.
Undercorrections. If the laser removes too little tissue from your eye, you won’t get the clearer vision results you were hoping for. Undercorrections are more common for people who are nearsighted. You may need another LASIK procedure within a year to remove more tissue.
Overcorrections. It’s also possible that the laser will remove too much tissue from your eye. Overcorrections may be more difficult to fix than undercorrections.
Astigmatism. Astigmatism can be caused by uneven tissue removal. It may require another surgery, glasses or contact lenses.
Flap problems. Folding back or removing the flap from the front of your eye during surgery can cause complications, including infection and excess tears. The outermost corneal tissue layer may grow abnormally underneath the flap during the healing process.
Corneal ectasia. Corneal ectasia, a condition in which the cornea is too thin and weak, is one of the more-serious complications. The abnormal cornea tissue is unable to maintain its shape, which can lead to cornea bulging and worsening vision.
Regression. Regression is when your vision slowly changes back toward your original prescription. This is a less common complication.
Vision loss or changes. Rarely, surgical complications can result in loss of vision. Some people also may not see as sharply or clearly as previously.

Conditions that increase risks

Certain health conditions can increase the risks associated with LASIK surgery or make the outcome less predictable.

Doctors may not recommend laser refractive surgery for you if you have certain conditions, including:

Autoimmune disorders, such as rheumatoid arthritis.
A weakened immune system caused by immunosuppressive medications or HIV.
Constantly dry eyes.
Recent changes in vision due to medicines, hormonal changes, pregnancy, breastfeeding or age.
Inflammation of the cornea, lid disorders, eye injuries or eye diseases, such as uveitis, herpes simplex affecting the eye area, glaucoma or cataracts.
Disorders of the cornea, including keratoconus or corneal ectasia.

LASIK surgery is usually not recommended if you:

Have an eye disease that causes the cornea to thin and bulge, such as keratoconus.
Have a family history of keratoconus or other corneal ectasia.
Have good overall vision.
Have severe nearsightedness.
Have very large pupils or thin corneas.
Have age-related eye changes that cause vision to be less clear.
Participate in contact sports that may be associated with blows to the face.

If you’re considering LASIK surgery, talk to your doctor about your questions and concerns. Your doctor will discuss whether you’re a candidate for the procedure or other similar procedures.

Long-Sighted Laser Eye Surgery Cost

The cost of LASIK eye surgery varies drastically, ranging anywhere from $1,000 to $4,000 per eye. However, the average price for LASIK surgery in the U.S. in 2020 was $2,632 per eye, according to a 2021 report in Clinical Ophthalmology^[1]. It’s worth noting that advertisements offering LASIK for as low as $250 dollars are often for minimal corrections, and are often teaser rates to attract patients to seek more information.

Several factors can affect the cost of LASIK, says Vicente Diaz, M.D, an ophthalmologist and assistant professor of ophthalmology and visual sciences at Yale School of Medicine in New Haven, Connecticut.

The first is geographical location. “There are macro trends in terms of some areas having a higher cost of living than others and so elective procedures such as refractive surgery tend to follow those trends,” he says.

The doctor’s overhead can also influence price, explains Diaz. For example, if your doctor owns the laser equipment outright, then the marginal cost of doing a procedure is lower and they can pass those savings to the patient. However, doctors who are leasing, or who have a high cost per case, need to raise their price to make it worthwhile economically.

Price also fluctuates depending on the brand power or experience of the doctor or center. “If the doctor is in high demand, usually because of a well-deserved reputation, then that surgeon’s time is at a premium and market forces will drive the price up,” says Dr. Diaz.

However, the cost of surgery should not depend on how bad your eye vision is. “LASIK is typically a set price, as it covers the cost of correction within LASIK’s safe treatment range from minor to high corrections of nearsightedness, farsightedness and astigmatism,” says Neda Shamie, M.D., a LASIK, cataract and corneal surgeon at the Maloney-Shamie Vision Institute in Los Angeles and a Forbes Health Advisory Board member.

However, for patients that are not candidates for LASIK due to severe nearsightedness or farsightedness (or other factors), they may be candidates for higher-cost surgeries such as implantable contact lens (ICL) or refractive lens exchange (RLE). Typically, both ICL and RLE surgery is more expensive than LASIK.

What is Included in the Cost of LASIK?

Your overall cost can also be influenced by what’s included in the surgery and the prices associated with those inclusions, such as follow-up appointments and enhancements. “An enhancement is a second procedure done on a previously operated eye,” says Dr. Shamie.

A small percentage of patients (less than 5%) after an initial refractive procedure (such as LASIK) benefit by having a fine-tuning laser procedure, due to residual nearsightedness, farsightedness or astigmatism after their primary surgery.

“Patients more likely to need enhancements include those with large prescription corrections at their first surgery,” she adds.

While services that are included in the cost of your LASIK surgery will vary depending on the surgeon, Dr. Shamie explains that the total cost typically includes the following:

Pre- and post-operative exams for at least one year
Facility and surgeon fees
Postoperative eye drops
Follow-up procedures should there be a need for fine-tuning the correction

Additional Costs of LASIK

In terms of the surgery itself, there shouldn’t be additional LASIK costs, according to Dr. Shamie, “unless you have it performed by a surgeon who offers the procedure at a low upfront cost and charges separately for the more advanced and safer technology, follow-up visits and medications.”

However, any type of a la carte pricing to minimize costs is not recommended, “because the latest technology and follow-up care are essential to an excellent outcome, not optional line items,” she says.

Some LASIK centers, though, may charge more for “custom” procedures over standard.

“Custom surgery is when a map of the patient’s actual cornea is used to treat higher-order aberrations caused by the shape of that particular patient’s eyes,” says Dr. Diaz. This is more time-consuming than standard LASIK procedures, as it takes into account the particular eye shape.

Other costs may include medications needed to recover from surgery, says Dr. Diaz, however, these are typically covered by medical insurance and are subject to copay arrangements.

Eye Laser for Shortsightedness